When and how to treat acute hepatitis C?

Abstract

Background: Appropriate treatment of acute hepatitis C is still a matter of controversy due to the lack of large controlled trials.Aim: To assess the effectiveness of interferon as treatment for acute hepatitis C by meta-analysis. Methods: MEDLINE search (1985 -2002) was supplemented with manual searches of reference lists. Studies were included if they were controlled trials comparing interferon to no treatment and if they included patients with either post-transfusion or sporadic acute hepatitis C. Twelve trials were analyzed (414 patients). The outcome assessed was the sustained virological response (SVR) rate (undetectable hepatitis C virus RNA in serum at least 6 months after cessation of therapy).Results: Interferon significantly increased the SVR (risk difference 49%; 95% confidence interval 32.9 -65%) in comparison to no treatment. The risk difference of SVR increased from 5 to 90% when trials were ordered by increasing interferon weekly dose. Delaying therapy by 8 -12 weeks after the onset of disease does not compromise the SVR rate.Conclusions: Current evidence is sufficient to recommend interferon treatment of patients with acute hepatitis C. A later initiation of therapy yields the same likelihood of response as early treatment. A daily induction dose during the 1st month is the best option of treatment. q

Acute hepatitis C: In search of the optimal approach to cure

“…The SVR rate was significantly higher in the early-intervention group (87%, 13 of 15 patients after short-term therapy alone, and 100% after follow-up retreatment) than in the late-intervention group (53%, 8 of 15 patients after short-term therapy with or without follow-up therapy). Thus this trial, in accordance with our meta-analysis, 13 shows that delaying therapy up to 8 weeks after onset does not affect the SVR rate. Delaying the start of therapy would in fact avoid unnecessary treatment of those patients who would spontaneous clear the virus.…”

“…Similar results were obtained by Delwaide et al, 25 who used the same high induction dose. Our meta-analysis 13 provides further evidence that treatment with a daily dose of standard IFN is the best option for obtaining a SVR. All these studies have used non-pegylated IFN alfa and tried to optimize pharmacodynamics by giving it daily.…”

“…11 Since 2001, when a cohort study by Jaeckel et al 12 demonstrated that 6 months of treatment with standard IFN alfa 2b at doses comparable to those used for chronic hepatitis was enough to eradicate HCV infection in 98% of patients with acute hepatitis C, the issue of optimal treatment of AVH due to HCV has been a matter of hot debate. Albeit a fair number of studies (reviewed by metaanalysis in 13 ) show a net benefit of IFN therapy over no treatment in terms of duration of viraemia, rate of chronicity, and duration of biochemical alterations, there is still no consensus on whom to treat and the timing of treatment. This is reflected by a lack of precise recommendations in the most recent consensus statements from the NIH 14 and EASL.…”

“…21 Trials performed between 1991 and 2002 were highly heterogeneous in this respect, as treatment was started at widely variable intervals after the clinical onset of AVH. In order to overcome heterogeneity, we have performed a meta-analysis of controlled trials 13 to define the best timing and the optimal treatment strategy to avoid chronicity of HCV infection while reducing treatment to a minimum. Twelve trials were analyzed (414 patients).…”

Making the Best of a Bad Situation: Early Chronic Nosocomial HCV infection

“…Pharmacologic therapy for acute HCV infection has not been standardized regarding medication or duration, but has been demonstrated to be cost-effective in two metaanalyses [14,16]. Interferon monotherapy, both unmodified and PEGylated, has been the mainstay of clinical trials and has been rewarded with very high rates of sustained virologic response (SVR).…”